Personal Information Today’s Date Name



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East Greenville Animal Hospital

Application for Employment



Personal Information Today’s Date_________________________

Name________________________________ Social Security #_____________________

Address_________________________________________________________________

City___________________________________ State___________ Zip_______________

Home Phone (____)_________________ Cell Phone (____)_______________________

If you are less than 18 years of age, please list your date of birth here: ____________




Job Interests/Desires

Position(s) applying for________________________ Desired hourly wage_________________

Type of employment requested: ___Full Time ___Part Time ___Temporary ___Summer

Days/Hours you are NOT available:_______________________________________________

Ideal Number of Hours per week: _________ per week

Maximum Hours You Can Work: _________ per week

Are you able and willing to work weekends and holidays:____________________

Date you could begin working: ______________________


Employment/Volunteering History

Please list employment and/or volunteer positions starting with the most recent position. Please account for any time periods not listed below.




  1. Name of Business: _______________________________________________________

Address: _______________________________________________________________

Phone Number: _________________Dates of Employment: ____________________ Position Held: ________________________ Job Title: _________________________

List of Duties: ___________________________________________________________

Supervisor: _______________________ Reason for Leaving: __________________

May we contact this employer? ___Yes ___No


  1. Name of Business: ______________________________________________________

Address: _______________________________________________________________

Phone Number: _________________Dates of Employment: ____________________ Position Held: ________________________ Job Title: ________________________

List of Duties: ___________________________________________________________

Supervisor: _______________________ Reason for Leaving: __________________

May we contact this employer? ___Yes ___No



  1. Name of Business: _______________________________________________________

Address: _______________________________________________________________

Phone Number: ________________Dates of Employment: _____________________ Position Held: _______________________ Job Title: _________________________

List of Duties: ___________________________________________________________

Supervisor: ______________________ Reason for Leaving: ___________________

May we contact this employer? ___Yes ___No


  1. Name of Business: _______________________________________________________

Address: _______________________________________________________________

Phone Number: ________________Dates of Employment: _____________________ Position Held: ________________________ Job Title: ________________________

List of Duties: ___________________________________________________________

Supervisor: _______________________ Reason for Leaving: ___________________

May we contact this employer? ___Yes ___No

Education

Type of

Education

Name and Location

Degree, Certificate, Diploma Received

# of years attended

High School










College or

University










Other











Have you ever been convicted of a felony?________________

Do you use drugs and/or alcohol or smoke on a regular basis?_______________

I certify that the information that I have provided in this application is true and correct. I understand that if any of this information is found to be false after employment is granted, employment may be dismissed. I also understand that East Greenville Animal Hospital may conduct pre-employment and/or employee drug and/or alcohol screening/testing.

_________________________________________Signature of Applicant _____________ Date


References

Business References: (Do not list relatives) Please indicate if you were employed under a different name.



Name

How you know them

Phone Number

Title

Years Known















































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